Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CDCA.040437 | OH |
NPI | 1003329798 |
---|---|
Provider Name | Von Richard Graham |
First Address | Columbus, OH 43211-2603 |
Second Address | Columbus, OH 43211-2603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2017 |
Last Update Date | 16/11/2017 |